The Supervisory Alliance: Facilitating The Psychotherapist’s Learning Experience (Book Review)

Author:  Gill, Susan (Editor)
Publisher: Jason Aronson, 2002
Reviewed By: Michael Wm. MacGregor, Spring 2003, pp. 48-50

What is the experience of the supervisor when supervising? What is the experience of the supervisee when in supervision? How does one learn to supervise? At times it is almost assumed that a psychotherapist can become a supervisor simply because he or she has been in supervision and has seen his or her own supervisor work. Although all psychotherapists receive supervision during the course of their education, very few are exposed to the theory of supervision, and fewer still gain practical and supervised experience in the provision of supervision. The Supervisory Experience: Facilitating the Psychotherapist’s Learning Experience discusses supervision from a psychodynamic perspective and explores supervision from the supervisor’s and the supervisee’s perspective. This book provides a greater understanding of what is happening in the supervisory relationship and will be of interest to supervisors and supervisees alike. Susan Gill has brought together a number of well-known and published psychoanalytic/psychodynamic authors to discuss the process of supervision. She has succeeded in creating an edited book that is of benefit to the novice and the experienced supervisor, while still being accessible to students learning the process of supervision. This book is divided into two sections: The psychotherapist’s learning experience and countertransference.

Facilitating the Psychotherapist’s Learning Experience
The first section of this book introduces the reader to psychoanalytic/psychodynamic supervision and explores issues related to working with anxiety, transference, vulnerabilities, and superego issues. In the first chapter, Stanley H. Teitelbaum discusses the historical nature of psychoanalytic supervision by addressing issues such as the didactic versus experiential nature of supervision, and the concept of an “expert supervisor” He also discusses more recent developments that have occurred in psychoanalytic supervision including the emergence of a relational model of supervision, which addresses supervisee vulnerability and anxiety, and the democratization of the supervisory relationship. Along with this later point, the author discusses the importance of supervisors “nondefensively exploring their own blind spots or supertransferences” (Teitelbaum, 1990). Teitelbaum discusses the importance of “cultivating the supervisory alliance as a precondition for meaningful teaching-learning” Finally, he discusses the impact of supervision on the supervisor in terms of narcissistic needs, and in terms of the importance of adapting supervisory approaches to the appropriate learning and developmental levels of the supervisee. Teitelbaum provides a succinct overview of important developments occurring in psychoanalytic supervision and provides a foundation on which subsequent chapters develop.

Susan Gill explores narcissistic vulnerabilities in the supervisee in terms of the ego ideal and self-exposure. She starts off by exploring Freud’s concept of the ego ideal (Freud, 1914) and then discusses Schafer’s idea of the ideal self and the experienced self (Schafer, 1967). She uses these concepts to discuss how the tension between the experienced self and the ideal self affect narcissistic strivings and can lead to feelings of failure and humiliation. These themes are continued in the chapter as Gill explores the tension that exists in trainees between the “all knowing therapist” and the “unknowing supervisee.” She presents Brightman’s Kohutian model to describe the “process of change in the area of professional narcissism” (Brightman, 1984) and then uses case examples to discuss self-exposure as a source of narcissistic vulnerability. The use of clinical vignettes is particularly helpful in clarifying how fear of exposure may keep supervisees from identifying feelings that are contradictory to internal ideals. Finally, Gill moves beyond narcissistic vulnerabilities as a normal part of supervisee learning to a discussion of supervisees with narcissistic character defenses and how these defenses can create significant learning and therapeutic problems.

Sydney W. Arkowitz continues to explore vulnerabilities in the supervisee by discussing perfectionism. He discusses how the supervisory relationship, intended to be safe and facilitate learning, can lead to uncertainty, vulnerabilities, and regression. He argues that this is brought about when perfectionism in the supervisee is the result of unresolved grandiosity, unrealistic ego ideals, and harsh superego structures rather than a striving for mastery and competence. Arkowitz discusses how the supervisor can use supervision to modify the supervisee’s superego ideal, soften the superego structures, and decrease grandiose needs. In order to facilitate this, Arkowitz describes how the supervisor can become a new ego ideal; an ego ideal that demonstrates that perfection forever eludes it and is willing to be imperfect. Arkowitz suggests that supervisor’s can become this new ego ideal by allowing supervisees to see his or her shifts in thinking, feelings of countertransference, projective identifications, and failures of empathy. He argues that by doing this the supervisee will internalize a new identification. The supervisee will relinquish the idea of the supervisor as omnipotent and therefore also relinquish his or her need to be omnipotent. Arkowitz uses a number of case examples to exemplify these concepts and to help the reader understand how to work with supervisee perfectionism.

Susan Reifer briefly discusses how supervisors can understand and deal with supervisee anxiety over being a new or beginning therapist. She discusses how success or failure is often viewed by the supervisee as a reflection of his or her own personality and character, and how supervisors need to recognize this. She explores feelings of omnipotence and how part of what supervisees may be dealing with is the need to “master their own narcissistic trauma of being used by parents as supporting objects” (Brightman, 1984). She then goes on to discuss three different approaches to help supervisees reduce their anxiety: Patient-centered, therapist-centered, and process-centered supervision.

Wilma C. Lewis’s chapter on transference in analysis and supervision takes a different approach from the previous chapters in that she presents two examples from her own experience as a supervisee (one positive and one negative). She briefly explains that how supervisors handle issues such as transference projections, displacements, etc., will ultimately impact on the success of supervision, and whether the transference reactions will continue to be reinforced (and an obstacle to supervision) or mitigated (and not impact supervision). This chapter provides an experiential perspective to supervision and highlights, from a supervisee perspective, many of the concepts touched on in this and previous chapters. It is an excellent opportunity for supervisors to reacquaint themselves with the anxieties etc., experienced by those in supervision.

Jennifer L. Roberts also recounts her own experience as a supervisee using the metaphors of performance anxiety or “stage fright.” Roberts refers to Gabbard’s work on “stage fright” as a universal experience to help the reader understand supervisee anxiety and to provide a theoretical context for her discussion. She discusses performance anxiety developing out of Oedipal and preoedipal conflicts such as exhibitionism, genital inadequacy, aggression, and fear of retaliation (Gabbard, 1979). She also cites Mahler’s (1975) stages of separation and individuation and Freud’s psychosexual stages of development to help understand key anxieties experienced by supervisees and how different types of anxiety may be related to separation and psychosexual development. Finally, she discusses narcissistic vulnerability and suggests that supervisors need to be sensitive to ego ideal conflicts, self-exposure concerns, and narcissistic character defenses (Gill, 1999) when dealing with supervisees. She then suggests the importance of building a positive alliance and discussing transference rather than facilitating a transference neurosis in supervision. Like the previous chapter, this chapter helps the reader further understand the experiences of the supervisee and the anxieties he or she may experience.

Iris Levy explores superego issues that emerge in supervision from both the supervisee’s and the supervisor’s perspective. Again, by looking at this issue from the supervisee’s perspective, Levy’s discussion follows that of the previous two chapters. She begins by discussing the origin and function of the superego, and then considers how and why superego issues develop in supervision. Levy discusses how one of the most typical compromises a supervisee enacts when faced with overwhelming anxiety is the projection of their punitive and perfectionistic superego onto the supervisor. This results in experiencing the supervisor as critical and punitive. In terms of supervisor superego issues, Levy discusses concerns relating to competence to teach, taking on the role as an authority figure, competitive feelings, and issues related to having to evaluate students. Finally, Levy offers some technical advice for handling these issues in supervision and then ends the chapter by providing two clinical vignettes to illustrate these issues.

Carol Martino discusses supervision from a self object experience. She discusses the origin and function of self object experiences by drawing on the work of Kohut. She maintains that if the supervisees’ self object needs are met in supervision then there can be a greater sense of shared communication within the supervisor-supervisee dyad. Martino uses Wolf’s (1994) three self object experiences (adversarial self object, efficacy experiences, and vitalizing self object experiences) to help understand the developmental progress of supervisees and how they may relate to their supervisor. Martino finishes the chapter by presenting two clinical vignettes to help illustrate her self object perspective to supervision

The final chapter in this section of the book addresses what factors created the optimum learning environment in supervision. Mary B. M. Cresci provides four case examples of supervision sessions. She discusses what made the sessions successful and what facilitated learning from the supervisees perspective. She concludes the chapter by discussing how to better facilitate the supervisee’s learning experience. It is apparent that it is not only the supervisor’s theoretical orientation that is most helpful to the supervisee, but that the manner of supervision and the supervisor’s personality style also greatly affect the quality of supervision. She suggests that the degree to which the supervisee does not feel anxious and criticized (but instead feels relaxed and engaged) will determine the quality of the supervisory experience, and will determine the degree to which the supervisee can learn. Cresci also makes the point that different developmental levels in supervisees will determine the optimal learning situation.

Countertransference
The second section of this book is devoted to the issue of countertransference. The authors consider whether supervisors should encourage the disclosure of countertransference issues within the supervisory relationship. The first chapter by Lawrence Epstein begins by identifying aspects of the supervisory relationship that may disadvantage the supervisee and/or the treatment relationship, and then discusses how supervision can be structured to minimize these disadvantages. Epstein discusses the traditional model of supervision that focuses on the patient-therapist relationship and how this model ignores the concept of the practice of participant-observation. He then provides a case example of a supervisory failure to help illustrate this point. Epstein goes on to discuss a modified supervisory approach where the supervisor focuses his attention on the supervisee (i.e., focus on the supervisee’s feelings and reactions vis-à-vis both the supervisory and treatment situation). In this approach Epstein suggests that the supervisor needs to focus on the supervisory relationship in terms of active participant-observation. That is, the supervisor needs to be aware of the impact of his or her personality style, interventions, and the entire supervisory process on the supervisee. To facilitate this process Epstein provides specific examples of how to apply the participant observation approach to the supervisory relationship. He discusses issues such as overcoming resistance to accepting that supervision can fail, the use of object-oriented versus ego-oriented questions, and working with countertransference issues. The author finishes the chapter by providing three vignettes to help illustrate the points he discussed.

Winslow Hunt further explores how to use countertransference in supervision. He provides a theoretical rationale for incorporating countertransference into supervision and then provides some guidelines for when and how to incorporate it. Through the use of clinical vignettes the author describes how countertransference can be used to better understand the supervisee-supervisor and supervisee-patient relationships.

Howard E. Gorman also uses a clinical example to illustrate the positive use of countertransference in the supervisory relationship. Gorman argues that “interpreting countertransference in the supervised case, and transference and countertransference in the supervision itself” can be used to promote therapeutic progress and growth of the supervisee (Gorman, 1996). He provides an extensive clinical example that illustrates the beneficial nature of using countertransference in supervision. Gorman is careful to state, however, that interpreting countertransference should not become the sole focus of supervision. He argues that discussion of countertransference issues should be undertaken when it has the potential to benefit the supervisee, the supervisee-supervisor relationship, and the patient. He challenges the reader to think about interpretation of the transference in a broader context beyond the “deep, general, and reconstructive interpretation that forms a very small, albeit crucial, part” of psychoanalysis (Lester & Robertson, 1995). This chapter argues for the appropriate use of countertransference in supervision and provides a clinical example indicating how this information can be used beneficially in supervision and inform treatment.

Anne E. Bernstein and Susan C. Katz describe the rarely reported phenomenon of a supervisor and a supervisee both dreaming about a patient, and then using that dream information to facilitate supervision and to better understand the patient. They use case material from supervision to illustrate how a well-developed supervisory relationship can facilitate the discussion of material such as dreams, and how dreams can be a reflection of the process occurring between the supervisor and the supervisee.

The final chapter in this book discusses transference-countertransference dynamics and disclosure in supervision. William J. Coburn presents three tenets of the supervision experience. The first is that the primary subject matter of the relationship is the patient’s subjective world. The second is that the relation between the supervisor and supervisee is the result of transference-countertransference interactions among the supervisor, the supervisee, and the patients. The third is that the exploration of these relations is what is most valuable to the supervisee’s and the patient’s development and progress. From an intersubjective position the author presents case material to illustrate these points. Coburn discusses how a supervisor’s disclosure can help a supervisee feel understood on an emotional level and how this models a relationship that can be internalized by the supervisee.

In summary, The Supervisory Experience: Facilitating the Psychotherapist’s Learning Experience edited by Susan Gill offers a framework for understanding some of the issues surrounding supervision from both the supervisor’s and the supervisee’s perspective. The first section of the book addresses how to work with anxiety, transference, vulnerability, and superego issues. The authors explore a range of topics such as models of supervision, perfectionism, narcissism, and personal experiences, and discuss how best to facilitate supervision and supervisee learning. The second section of this book addresses the specific issue of countertransference. The authors discuss how countertransference can be used to facilitate supervisee development, and inform both the supervisory relationship and treatment. The Supervisory Experience addresses a number of important issues in supervision. For the new supervisor this book is an excellent resource that is filled with theoretical and practical information. For the more experienced supervisor, the book offers a more detailed examination of a number of key issues related to supervision and the supervisory relationship.

References

Brightman, B. K. (1984). Narcissistic issues in the training experience of the psychotherapist. International Journal of Psychoanalytic Psychotherapy, 10, 293-317.
Freud, S. (1914). On narcissism: An introduction. Standard Edition, 14, 67-107.
Gabbard, G. O. (1979). Stage fright. International journal of Psychoanalysis, 60, 383-392.
Gill, S. (1999). Narcissistic vulnerabilities in psychoanalytic psychotherapy supervisees: Ego ideals, self-exposure and narcissistic character defenses. International Forum of Psychoanalysis, 8, 227-233.
Gorman, H. E. (1996). Interpretation of transference in psychoanalytic psychotherapy. Free Associations, 39, 379-402.
Lester, E. P., & Robertson, B. M. (1995). Multiple interactive processes in psychoanalytic supervision. Psychoanalytic Inquiry, 15, 211-225.
Mahler, M. S., Pine, G., and Bergman, A. (1975). The psychological birth of the human infant. New York: Basic Books.
Schafer, R. (1967). Ideals, the ego ideal, and the ideal self. Psychological Issues, 5, 131-174.
Teitelbaum, S. H. (1990). Supertransference: The role of the supervisor’s blind spot. Psychoanalytic Psychology, 7, 243-258.
Wolf, E. (1994). Selfobject experiences: Development, psychopathology, treatment. In S. Kramer & S. Akhtar (eds.), Mahler and Kohut: Perspectives on development, psychopathology, and technique (pp. 65-96). Northvale, HJ: Jason Aronson.

Reviewer Note

Michael Wm. MacGregor, Department of Psychology, University of Saskatchewan. Correspondence can be sent to: Michael Wm. MacGregor, PhD, Department of Psychology, University of Saskatchewan, 9 Campus Drive, Saskatoon, Saskatchewan, S7N 5A5. Telephone: (306) 966-2525. Facsimile: (306) 966-6630.

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